If your cow dies, that is a tragedy; if your wife dies, you can always get another

Last time I got this angry was when president Karzai of Afghanistan signed a bill making it legal to rape your wife. Inspiration for the post today comes from Dr. Kristof's column in the New York Times on July 18th writing about the great work Dr. Shershah Syed is doing in Karachi in the field of maternal health. In this column a reference to a third world male chauvinistic view "If your cow dies, that is a tragedy; if your wife dies, you can always get another" made me feel sick. Passionate male patriots will deny the existence of this view altogether but it is a fact that many traditional societies including rural areas of Pakistan have similar kinds of views about their woman - the cow gets replaced with a horse in Belarus, for example.

What struck a chord with me in Dr Shershah's interview was story of Ashrafi, a woman from rural Sind. Her plight, though deeply moving personal story, is representative of a vast majority of woman in Pakistan (and other developing countries) who suffer due to poverty, ignorance and lack of education.

Ashrafi "tried to deliver at home with the help of [a 'DAI'] an untrained birth attendant. But her pelvis wasn’t big enough to accommodate the baby’s head, so four exhausting days of labour produced nothing. Finally, the family took Ashrafi to a clinic, and the baby was delivered dead. Then she found that she was dribbling urine and stool through her vagina. She smelled, and the salts in her urine left sores on her thighs.

Ashrafi had heard that doctors in Karachi might be able to cure her, and she asked if someone could take her. Instead, Ashrafi’s husband divorced her. Embarrassed and humiliated, Ashrafi fell into a deep depression. She locked herself up in her parents’ home and refused to see anyone.

Thirteen years passed. Ashrafi says she didn’t leave the house once. I asked her, and a cousin of hers whom I reached by telephone, how she spent her days. The answer: sewing, caring for her sick mother — and crying. Her case turned out to require a series of operations because of the long wait. But after six months of surgeries, she should be repaired and ready to go home by the end of this month."

Moving description of Ashrafi's life and the work that Dr. Shershah is doing in Karachi encouraged a number of caring people to comment and share the extent of the problem across the world. I find it unacceptable that in 2009 "two million women today are walking the earth dripping urine and/or faeces because of an un-repaired childbirth injury called obstetric fistula. Quite often it is because a family and a nation have allowed a very young girl to be married". "The problem of fistulas is worldwide, and tied both to girls getting married and pregnant at very young ages, and inadequate and absent care before, during, and after childbirth".

Concerned about the scale of maternal health problems in Pakistan I support a UK based charity International Foundation for Mother and Child (IFMCH) hoping that IFMCH and a number of other very active charities on the ground and heroes like Dr Shershah might be able to bring a change to this situation. It is, however, vital to marshal voices to bring maternal and infant mortality high on the government agenda. Dr Shershah believes that a government, that despite dire economic situation decided to become a nuclear power because it was deemed to be a priority, can change the maternal health situation if only it was on their list of things to do. Unless this happens "there will be more young women bleeding to death for lack of trained caregivers at their births. There will be more Ashrafi Akbars, locked away behind doors for dozens of years because of an injury that no woman should ever have to sustain in giving birth to a child"

I personally know a large number of Pakistani professionals who are on the verge of leaving it all behind and heading to Pakistan to contribute to making a change hand on. I sign off sharing an email from a Pakistani doctor working abroad on similar crossroads.

"A few summers back , I was waiting for someone at the Baltimore airport. A weathered out, white woman in a long dress came over and started talking to me.


She asked me if I was from India. I told her that I am from Pakistan. She then started a conversation about monsoon, and being an expert in BS, I went on my authority mode about the monsoons. She kept correcting me, at which I had to ask her how does she know about it. She told me that she has been working in Chennai, for the last some years and in the monsoon season. In fact she lived there all those years and had just come back home to leave again. I was a little peeved at the direction the conversation was going , so I tried to change the subject. Then she asked me what do I do for a living. I told her that I am a physician. Her next question was that What are you doing here ? I told her that I am waiting for someone. She looked at me and said, No, In USA, in this country? Why are you here ?

The next few minutes were one of the most difficult in my life, blaming myself for not judging the situation, and trying to find a way out of this quagmire. Using all my skills, I tried my best rationalization, but knowing pretty well it is not gonna sell, I kept on.

I found out that she was a missionary working in the poorest regions of India, living with them and helping them with their daily lives. Working in the small clinic, set up by her group. Her question was plain and simple, why are you not helping your people? She opened up the wounds that I had suppressed deep down in a dark corner of my mind.The rationalization was strong , but proved once again to be the weakest, especially when there was a strong argument sitting next to me.

I have not forgotten that evening to this day, and I have five different plans that I am working on, in my subconscious all the time. The seven inches of rain in Karachi, without electricity, has put a lot of clauses on those plans!!